2 April 2013

Joseph Ting: Happy pills

WESTERN culture seems to live by the dictum “I deserve to be happy”, wanting a quick fix and a one-off prescription for happiness.

We are all a little frayed by the destabilising forces and pace of contemporary life. Beyond personal struggles at work and home, society is assailed by economic uncertainty, environmental degradation, overcrowded living, escalating competition and diminishing access to opportunity and health care.

A good start to coping with these pressures is to become more resilient by accepting sadness, physical discomfort and the toil of ageing as part of the course of human life. Learning from adverse experience and lowering our expectations of a satisfactory and happy life are a good start to reshaping life’s journey.

Freud is credited with saying that the most we can hope for is “ordinary unhappiness”, while ancient Greek playwright Aeschylus expected much less, “call(ing) no man happy until he is dead”. However, Socrates believed happiness resulted from having a purpose in life, striving to live a meaningful life and doing good work.

The fixation with and relentless pursuit of happiness can become psychologically burdensome, even destructive.

Most of what life throws at us does not require antidepressants, as that risks medicalising normal human distress and viewing ordinary sadness as mandating drug treatment.

Happiness is based on optimising the rate and flow of neurotransmitters in the brain in the right circuits at the right time. Pharmaceutical marketing claims that this can be achieved biochemically with drugs.

However, this can lead to heightened expectations, with drugs and medical devices used beyond their true capability, with no clear benefit. Time-scarce doctors adopt, and patients demand, the easy convenience of a “drugs first, talk later” approach.

There is no convincing evidence that antidepressant drugs aimed at manipulating our brain neurochemistry benefit those who want to deflect the impact of any brief or mild adverse experience that will eventually resolve without intervention.

Antidepressants are only effective in alleviating debilitating depression in conjunction with close psychiatric care.

Doctors are too readily providing medications when non-drug approaches such as counselling and reassurance could be just as, if not more, effective but without the side effects.

Big Pharma would like doctors and patients to believe depression is a defined disease that functions independently of character and will, and is treatable with antidepressants. To increase antidepressant use, they classify sadness and stress as a disease that merits medication.

Have modern humans really become so much unhappier, or is the reduced stigma of psychological problems, better self-reporting of symptoms, increased willingness to diagnose depression, reduced diagnostic thresholds, increased community awareness and better surveillance contributing to the depression epidemic?

Robert Burton, in the Anatomy of Melancholy published in 1621, gives pause for thought: “The manner of living is to more purpose than whatsoever can be drawn out of the most precious boxes of the apothecaries.”

Dr Joseph Ting is a senior staff specialist in the department of emergency medicine at Mater Health Services, Brisbane, a retrieval and clinical coordination consultant with Careflight Medical Services & Retrieval Services Queensland, adjunct research fellow at Griffith University School of Medicine and clinical senior lecturer in the division of anaesthesiology and critical care at the University of Queensland. He currently works for the East Anglia Air Ambulance in Cambridge, England.

Posted 2 April 2013

4 thoughts on “Joseph Ting: Happy pills”

In light of the social changes that we have had over the years some psychiatrist treatments and definition of terms used to diagnose need modification and redefinition. Like Kath Ryan (MJA InSight, 2nd April) I too am not a health professional but perhaps more educated in this aspect than average patients that doctors face every day. I have a wonderful specialist who is thoughtful, wise, and is able to comprehend the problems outside his arena and guide appropriately. Comparing and expecting similar care from all health professionals is neither fair nor achievable, perhaps demand for such care will be contentious. However, I feel such depth of knowledge is required to handle and to redefine some medical terms and subsequently using medicine to curb the non-medical problem. I totally agree with Dr Ting. It is time that professionals look carefully into social and behavioural aspect of patients in concordance. Medicine cannot be an answer to lost love or disastrous family dynamics and a psychiatric disorder should be reanalysed in light of social changes that we have in our modern life before introducing “Happy Pill”.

I am a counsellor and a clinical hypnotherapist that has been in practice since 1989. I have worked in a trauma and pain rehabilitation private practice, I have worked as a child sexual assault counsellor and I work in private practice now. There is endogenous or reactive depression and anxiety. For reactive depression and anxiety, doctors put a lid over the feelings but they not release the feelings. Sure it helps them cope in a low mood type of way – but with many client’s that find their way to my door, they are still looking for a way to feel better many years later while still on medication. As Dr. Ting says, Doctors are too readily providing medications when non-drug approaches such as counselling and reassurance could be just as, if not more, effective but without the side effects.

Sometimes the medications are required to allow the patient’s depression and anxiety to come sufficiently under control for non-drug approaches to be implemented. If they are so paralysed they can’t leave the house, or get out of bed, they’re unlikely to be able to engage in exercise or counselling.

I graduated in Psychology and my professor told me to go to Medical School. I graduated in Medicine then did post-grad training in psychological medicine/psychiatry. Although supposedly semi-retired after 30 years in specialist practice, I am still helping patients get off the ‘quick-fix pills’ as long as they are not truly indicated by an accurate diagnosis. And substituting eclectic strategies to live more satisfying, if not happier lives. I teach CBT/RET, Zen meditation, hypnosis, relaxation; advise on healthier lifestyles etc. etc. I believe most of my patients benefit because I work according to the dictum: cure sometimes, relieve often, comfort always. The origins of this dictum are lost in antiquity but remain true of ‘real’ doctors still. I definitely agree with Dr Ting’s views.